Abstract Details

Title Perioperative Practices of Moyamoya Syndrome Undergoing Revascularization

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) Neurocritical Care Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 046

Objective

We investigated practice patterns among a transdisciplinary group aiming at identifying possible heterogeneity of practices on key components of care that warrant prospective studies.

Background There are no evidence-based resources guiding the perioperative management of Moyamoya patients undergoing revascularization surgery.

Design/Methods We administered a web-based survey comprising 62 questions pertaining to multiple demographics of respondents and several aspects of pre-, intra-, and post-operative care to physician members of the Neurocritical Care Society, Society of Critical Care Medicine, �鶹��ýӳ��, Society for Neuroscience in Anesthesiology and Critical Care, and American Association of Neurological Surgeons.

Results Analysis of 155 responses that have managed at least one adult Moyamoya syndrome patient in the last 24 months (out of 207 total responses) from 15 countries (87.4% US) captured input from overlapping disciplines [anesthesiology (27.9%), critical care medicine (24.5%), neurology (27.0%), neurosurgery (12.7%)], mainly from experienced providers (59.5% > 5 years beyond training) practicing in academic centers (84.4%). Arterial line for blood pressure recording is the most used method of monitoring perioperatively. Significant variability exists on selected level for transducing pressure: phlebostatic axis most commonly used in the pre- (46.8%) and post-operative (51.3%) phases, whereas circle of Willis/tragus is most widely used intra-operatively (59.0%). Neurosurgeon preference is the main contributor to the selection of perioperative hemodynamic goals. The median minimum and maximum intra- and post-operative SBP and MAP goals were 105-145 mmHg and 70-100 mmHg, respectively. Crystalloid infusion was the preferred method to achieve hemodynamic goals (90.7%), followed by norepinephrine (68.0%) and phenylephrine (62.9%); however, these vasopressors are considered contraindicated in this setting by 16.96% of respondents.

Conclusions Our results illustrate Moyamoya perioperative practice heterogeneity among different stakeholders. Heterogeneous hemodynamic augmentation practices is evident, which constitute equipoise for prospective studies targeting optimal strategies.

Authors/Disclosures
Melody Eckert PRESENTER	Miss Eckert has nothing to disclose.
Nilan Bhakta	Mr. Bhakta has nothing to disclose.
Marc Alain Babi, MD (Cleveland Clinic Foundation (Florida Region))	Dr. Babi has nothing to disclose.
Katharina M. Busl, MD, MS, F�鶹��ýӳ�� (University of Florida)	Dr. Busl has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Rissman Law. Dr. Busl has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Huffman Powell Baley. Dr. Busl has received personal compensation in the range of $500-$4,999 for serving as a Consultant for University Science. Dr. Busl has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for SCCM. Dr. Busl has a non-compensated relationship as a Board Member with Art in Medicine that is relevant to �鶹��ýӳ�� interests or activities. Dr. Busl has a non-compensated relationship as a Associate Editor with Critical Care Explorations that is relevant to �鶹��ýӳ�� interests or activities. Dr. Busl has a non-compensated relationship as a Assistant Editor with Neurocritical Care that is relevant to �鶹��ýӳ�� interests or activities.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Christopher P. Robinson, DO (University of Florida Department of Neurology)	Dr. Robinson has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for law firms.
William H. Roth, MD (New York Presbyterian Hospital, Columbia)	No disclosure on file
	No disclosure on file
	No disclosure on file
Carolina B. Maciel, MD, MSCR, F�鶹��ýӳ��	Dr. Maciel has received research support from American Heart Association. Dr. Maciel has received research support from National Institute of Health.